Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones

Abstract

BackgroundSelf-report is the most common method of measuring medication adherence but is influenced by recall error and response bias, and it typically does not provide insight into the causes of poor adherence. Ecological momentary assessment (EMA) of health behaviors using mobile phones offers a promising alternative to assessing adherence and collecting related data that can be clinically useful for adherence problem solving.ObjectiveTo determine the feasibility of using EMA via mobile phones to assess adolescent asthma medication adherence and identify contextual characteristics of adherence decision making.MethodsWe utilized a descriptive and correlational study design to explore a mobile method of symptom and adherence assessment using an interactive voice response system. Adolescents aged 12-18 years with a diagnosis of asthma and prescribed inhalers were recruited from an academic medical center. A survey including barriers to mobile phone use, the Illness Management Survey, and the Pediatric Asthma Quality of Life Questionnaire were administered at baseline. Quantitative and qualitative assessment of asthma symptoms and adherence were conducted with daily calls to mobile phones for 1 month. The Asthma Control Test (ACT) was administered at 2 study time points: baseline and 1 month after baseline.ResultsThe sample consisted of 53 adolescents who were primarily African American (34/53, 64%) and female (31/53, 58%) with incomes US$40K/year or lower (29/53, 55%). The majority of adolescents (37/53, 70%) reported that they carried their phones with them everywhere, but only 47% (25/53) were able to use their mobile phone at school. Adolescents responded to an average of 20.1 (SD 8.1) of the 30 daily calls received (67%). Response frequency declined during the last week of the month (b=-0.29, P<.001) and was related to EMA-reported levels of rescue inhaler adherence (r= 0.33, P=.035). Using EMA, adolescents reported an average of 0.63 (SD 1.2) asthma symptoms per day and used a rescue inhaler an average of 70% of the time (SD 35%) when they experienced symptoms. About half (26/49, 53%) of the instances of nonadherence took place in the presence of friends. The EMA-measured adherence to rescue inhaler use correlated appropriately with asthma control as measured by the ACT (r=-0.33, P=.034).ConclusionsMobile phones provided a feasible method to assess asthma symptoms and adherence in adolescents. The EMA method was consistent with the ACT, a widely established measure of asthma control, and results provided valuable insights regarding the context of adherence decision making that could be used clinically for problem solving or as feedback to adolescents in a mobile or Web-based support system.

Feasibility of Smartphones for Real-time Assessment of Adherence Behavior and Symptom Exacerbation for High Risk Youth and Adolescents with Asthma: A Pilot Study (Preprint)

“…Mulvaney et al previously demonstrated that EMAs focused on asthma are associated with established measures of asthma control (e.g., Asthma Control Test) but also noted the difficulty in obtaining patient self-reported medication use. [20] Our study adds to this research by using newer technology for passive collection of medication use data, BT inhaler devices, and demonstrating an association of contextual factors such as asthma symptoms and emotional state by EMA with the adherence device data. Calculated adherence over days, weeks, months, and years is a series of discrete events occurring in a patient's daily life that can be impacted by mood and motivation.…”

“…We cannot confirm the presence or absence of asthma symptoms reported with EMA, but previous studies suggest this approach is valid in multiple disease states including asthma. [19,20,23] Furthermore, individual participants may experience symptoms differently due to different body awareness and this could impact their symptom reporting and particularly their severity of reported symptoms. More so, as a pilot study, we permitted the youth and parent to decide if the child was to report symptoms alone or in collaboration with the parent.…”

“…[18] Ecological momentary assessment (EMA) is an established technique developed within the behavioral sciences that enables researchers to monitor disease symptoms, emotional state, and other contextual factors frequently in a real time natural environment avoiding recall bias. [19,20] Patient reported inhaler use collected via EMA has been correlated with validated severity self-report measures (e.g., Asthma Control Test) and used in clinical trials with smartphone based interventions. [20,21] Medication adherence devices previously used in clinical trials are now emerging as a practical tool for clinical practice as they readily connect with smartphones via Bluetooth (BT) technology, avoiding inaccuracies associated with self-report.…”

“…[19,20] Patient reported inhaler use collected via EMA has been correlated with validated severity self-report measures (e.g., Asthma Control Test) and used in clinical trials with smartphone based interventions. [20,21] Medication adherence devices previously used in clinical trials are now emerging as a practical tool for clinical practice as they readily connect with smartphones via Bluetooth (BT) technology, avoiding inaccuracies associated with self-report. [22] This emerging adherence technology combined with the near universal adoption of smartphones enables real time assessments of medication use and patient symptoms and mood.…”

Smart Phone Apps: An Innovative Approach to Improving Pediatric Medication Adherence

“…11,12,13 Over the past two years, the number of medication adherence apps available on the market significantly increased from 160 to 461. 14,15 This remarkable increase confirms the rising demand of medication adherence apps, which can be used by nearly all patient populations.…”